Physician career development: toward building a model

Virtually no managed care organization provides a comprehensive and integrated program for physician career development. That's the principal finding of a survey we carried out in Spring 1994 in which we interviewed several individuals who have proven instrumental in the creation of career development programs at their managed care organizations. We started our research with the hypothesis that career development programs for physicians--frequently the most highly paid category of employees and the ones often most directly involved in the delivery of health care--should parallel the mission of the organization. In many of the organizations we surveyed, the mission included clinical excellence, managerial competence, research, teaching, community service, and building shareholder equity. While each organization offered some component of career development--usually clinical improvement and management development--very few offered programs that fostered the continued professional development of physicians in other aspects of their missions. In most cases, even in organizations with stronger career development agendas, the programs were passive and were rarely linked to the overall "corporate" goal of the managed care institution. This critical disconnect makes it extremely difficult for health care organizations to develop a workable system of accountability for their career development programs.     

Mandatory seat belt laws in the states. A study of fatal and severe occupant injuries

This study examines the impact of mandatory seat belt laws on fatal and incapacitating injury rates in the states. Annual data for all 50 states for the period 1975-1991 are used. Pooled time series analysis is employed. The general conclusion that emerges from this analysis is that seat belt laws significantly impact state fatal injury rates. Primary enforcement and all-seat coverage provisions appear to be particularly effective in reducing fatality rates.     

Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

Long-term impact of Drug Abuse Resistance Education (D.A.R.E.). Results of a 6-year follow-up

The long-term effectiveness of Drug Abuse Resistance Education (D.A.R.E.) was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 twelfth-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although the authors found no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th grade, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample but not in a validation sample. Findings from the two studies suggest a possible sleeper effect for D.A.R.E. in reference to the use of harder drugs, especially among teenage males.     

The missing bridge: How immigrant networks keep Americans out of dirty jobs

Immigrants are over half of the new entrants in occupations in southwestern labor markets that range from farmworker to janitor to engineering professor. This paper explains how the availability of immigrant workers changes employment practices in ways that push and pull Americans out of jobs which remain "dirty" or unattractive to U.S. workers. An immigrant network that eventually takes over an enterprise's jobs can begin by accident or design. Accidental immigrant takeovers begin with pioneer workers who persist in high turnover jobs such as seasonal farmworker. These workers offer to bring their friends and relatives to fill vacancies as they occur. Takeovers by design sometimes follow a strike in which immigrants are recruited to be strikebreakers. After immigrants dominate the workforce, the language and culture of the workplace change in ways that make American workers feel out-of-place. Employers feel under no compulsion to upgrade dirty jobs as long as immigrant workers are available, so the technology and productivity of immigrant-enclave jobs tend to be frozen, guaranteeing that dirty jobs get less and less attractive to Americans. Indeed, industries dependent on immigrant workers often turn protectionist when they realize that even low immigrant wages are not sufficient to ensure their survival in the global marketplace. In this way, Americans lose out in several ways: They must compete directly with immigrant workers in the labor market, and then pay higher prices for the goods produced by immigrant workers because the industries preserved by them demand protection from imports. This paper will explore the manner in which immigrant networks displace Americans from dirty jobs and how the availability of immigrant workers can preserve sunset industries which turn protectionist. Examples from fruit and vegetable agriculture, garments, and shoes will be discussed.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

Financial management: Development of scales

This study is a contribution to the development of family resource management scales, specifically financial management scales. Principal axis factor analysis, with varimax rotation, is used to assess underlying relationships in 23 family resource management variables related to time and money resources. Reliability and content, construct, and criterion-related validity of the scales are assessed. Two scales that are reliable and have some degree of validity are developed: frequency of financial problems and frequency of financial management. The scales could be used in future research, teaching, or counseling to organize financial management concepts.Preparation of this research was supported in part by the Illinois Agricultural Experiment Station. Data were collected in conjunction with the cooperative regional research project NC-182, Family Resource Utilization as a Factor in Determining Economic Well-Being of Rural Families. Cooperating states are Arizona, California, Illinois, Indiana, Iowa, Kansas, Michigan, and Minnesota.She received her Ph.D. from the University of Illinois; her current research interests include gender roles, family financial management, and economic well-being.Her current research interests include family financial management and consumer bankruptcy. She received her Ph.D. from the University of Missouri.Her current research interests include the economic well-being of various family forms. She received her Ph.D. from the University of Illinois.She received her Ph.D. from the University of Illinois. Her research interests are economic well-being and quality of life.     

Factors associated with expectation of household's future financial condition

Path analysis is used to examine the causal relationships among selected objective and subjective factors associated with a household's expectation of future financial condition. Results indicate that respondents who perceive the effect of changes in the external environment on their own household's financial condition as positive are younger, have higher net worth, perceive more internal control over their situation, and report that most of the changes in the external environment are positive. Respondents who are younger, have higher income, perceive more internal control over their situation, and believe the effect of changes in the external environment on their household's financial condition are positive are more likely to be optimistic about their financial future. It is important that educators and financial advisors recognize the significant role perception of being in control plays in determining expectations of future financial condition.Journal Paper No. J-15256 of the Iowa Agriculture and Home Economics Experiment Station, Project No. 2809. Data were collected in conjunction with the cooperative regional research project NC-182, Family Resource Utilization as a Factor in Determining Economic Well-Being of Rural Families. Cooperating states are Arizona, California, Illinois, Indiana, Iowa, Kansas, Michigan, and Minnesota.Her current research interests include family financial management and consumer bankruptcy; she received her Ph.D. from the University of Missouri.She received her Ph.D. from the University of Illinois; her current research interests include gender roles, family financial management, and economic well-being.She received her Ph.D. from the University of Illinois. Her research interests are economic well-being and quality of life.Her current research interests include the economic well-being of various family forms. She received her Ph.D. from the University of Illinois.     

Protecting hospital records from discovery

One of the more burdensome tasks confronting hospital administrators and defense counsel in hospital liability cases is attempting to protect sensitive or confidential information contained in hospital records. Plaintiffs' counsel continue to refine and broaden document requests as they become more sophisticated and experienced, learning about additional categories of documents that may be helpful to their cause. There are conditions that protect documents from discovery, but the rules of privilege are complicated and are frequently misunderstood.